Provider Demographics
NPI:1528384062
Name:DESSEREAUX, LAUREN ANNE (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:ANNE
Last Name:DESSEREAUX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TOWNWOODS RD
Mailing Address - Street 2:
Mailing Address - City:IVORYTON
Mailing Address - State:CT
Mailing Address - Zip Code:06442-1270
Mailing Address - Country:US
Mailing Address - Phone:914-450-2710
Mailing Address - Fax:
Practice Address - Street 1:PEQOUT HEALTH CENTER
Practice Address - Street 2:52 HAZELNUT HILL ROAD
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:260-446-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI01676225X00000X
NY016124225X00000X
CT4730225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist